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1 

1762S-S 

NATIONAL  ASSOCIATION 


FOR  THE 

PROTECTION  OF  THE  INSANE 


AND  THE 


PREVENTION  OF  INSANITY. 


BOSTON : 

TOLMAN  & WHITE,  PRINTERS,  383  WASHINGTON  STREET. 
1880. 


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UNIVERSITY  OF  ILLINOIS  LIBRARY  AT  URBANA-CHAMPAIGN 


L161  — 0-1096 


NATIONAL  ASSOCIATION 


FOR  THE 


PROTECTION  OF  THE  INSANE  AND  THE  PREVENTION  OF 

INSANITY. 

The  evils  of  insanity  have  now  attained  such  magnitude,  that  the  organized 


institutions  and  devices  are  unable  to  cope  with  and  control  them.  The 


number  of  those  more  or  less  insane,  who  either  do  not  need  to  go  to  public 
institutions,  or  who  cannot  find  room  in,  or  be  supported  by  them,  is  increas- 
ingly large,  and  for  this  great  class  there  is  no  systematic  supervision  or 
guardianship. 


(ere  are  multitudes  of  insane  men  and  women  in  the  United  States  for 


thorn  no  special  provision  is  made  in  the  way  of  care  and  treatment.  Occa- 
qnal  legislative  and  other  investigations  have  brought  to  light  the  misery 
and  suffering  that  this  absence  of  special  care  and  treatment  has  produced. 
Furthermore,  even  when  it  has  been  supposed  that  this  has  been  secured  by 
the  establishment  of  State,  county,  and  city  insane  asylums,  these  have 
sometimes  failed  of  their  purpose  through  mismanagement,  or  a misconception 
of  the  proper  methods  to  be  used.  Thus  there  is  room  for  organized  effort 
to  improve  the  condition  of  the  insane.  Again,  inasmuch  as  each  State  has 
the  exclusive  control  of  the  policy  and  the  mode  of  management  of  the 
insane  within  its  borders,  it  would  seem  as  if  such  organization  were  desir- 
able to  unify  the  principle  and  the  practices  in  the  care  and  treatment  in  the 
United  States  generally.  Two  other  organizations  may  perhaps  be  supposed 
to  cover  the  same  field  with  the  new  society. 

The  Association  of  Superintendents  of  Insane  Asylums  was  established 
with  somewhat  similar  ends  in  view.  But  this  is  strictly  a professional  and 
technical  organization.  It  includes  only  the  medical  superintendents  of 
insane  asylums,  and  it  is  safe  to  say  that  their  interest  in  the  insane  bears  no 
greater  proportion  to  the  public  interest  in  the  same  class,  than  their  mem- 
bership bears  to  the  vast  number  of  the  insane  under  treatment,  together  with 
their  families  and  friends. 

The  Conference  of  Charities,  which  has  been  working  in  the  same  direction, 
falls  short  of  covering  the  whole  field,  in  the  fact  that  it  is  commensurate 
only  with  the  States  where  Boards  of  State  Charities  exist,  and  also  because 
its  energies  are  scattered  over  the  whole  ground  of  the  dependent  and 
criminal  classes.  This  National  Association,  then,  by  confining  its  labors  to 
a single  class,  but  the  whole  of  that  class  in  the  United  States,  wherever 
situated,  may  reasonably  hope  to  accomplish  more  in  the  line  of  its  purpose 
than  the  others  named,  especially  if  cooperating  with  them  in  the  general  aims. 
It  solicits,  therefore,  the  general  cooperation  of  all  friends  of  the  insane,  and 
all  interested  in  the  subject,  whether  connected  with  the  other  organizations 
named,  or  among  the  public  generally. 


254013 


4 


CONSTITUTION  AND  BY-LAWS 


The  fee  for  membership  has  been  made  very  small,  that  all  who  receive  this 
circular  may  be  induced  to  connect  themselves  with  the  Society,  and  to 
receive  and  circulate  the  documents  which  may  be  issued  by  its  publishing 
committee. 

Organizations  in  the  interests  of  the  criminal  classes  in  prisons  have  been 
long  in  existence,  and  have  been  successful ; for  this  greater  class  of  insane, 
who  have  all  the  criminal’s  punishments,  deprivation  of  liberty  without  the 
criminality,  there  is  at  present  in  this  country  no  organized  supervision. 

The  object  and  scope  of  the  National  Association  for  tbe  Protection 
of  the  Insane  and  the  Prevention  of  Insanity  are  perhaps  sufficiently 
set  forth  in  the  Constitution  which  was  adopted  at  the  meeting  for  the  organi- 
zation of  the  Association,  held  in  Cleveland,  Ohio,  July  1,  1880. 

THE  CONSTITUTION. 

This  Society  shall  be  known  as  the  National  Association  for  the 
Protection  of  the  Insane  and  the  Prevention  of  Insanity. 

The  methods  by  which  the  Society  proposes  to  attain  its  end  are  : 

First.  By  the  encouragement  of  special  and  thorough  clinical  and 
pathological  observations  by  the  medical  profession  generally,  as  well  as  by 
those  connected  with  asylums. 

Second.  By  enlightening  public  sentiment  as  to  the  nature  of  the  malady, 
the  importance  of  early  treatment,  improved  methods  of  management  and 
treatment  at  home  and  abroad. 

Third.  By  recommending  an  enlightened  State  policy,  which,  while 
neglecting  no  one  of  its  insane  population,  shall  so  administer  relief  and 
protection  as  not  to  lay  unnecessary  or  undue  burdens  upon  the  tax-payers. 

Fourth.  By  holding  public  meetings,  wherever  needed,  to  stimulate 
legislation  that  will  secure  efficient  State  supervision  of  all  public  institutions 
for  the  care  of  the  insane,  as  a mutual  safeguard  for  the  protection  of  society 
— the  patients,  as  well  as  those  who  have  them  in  charge. 

Fifth.  To  further  the  perfection  of  laws  relating  to  the  treatment  of  the 
insane,  and  their  rights  while  patients  in  the  asylum. 

Sixth.  By  efforts  to  allay  the  public  distrust  in  relation  to  the  manage- 
ment of  insane  asylums,  by  placing  them  on  the  same  footing  as  that  of  other 
hospitals,  both  in  the  matter  of  freer  communication  with  the  outside  world, 
and  the  privilege  of  a consulting  medical  staff  of  general  practitioners. 

The  Constitution  was  amended  so  that  it  might  be  amended  at  any  regular 
meeting  by  a vote  of  two-thirds  of  the  members  present. 

We,  the  undersigned,  form  ourselves  into  a Society  to  be  known  as  the 
National  Association  for  the  Protection  of  the  Insane  and  the 
Prevention  of  Insanity,  under  the  following  form  of  organization,  subject 
to  the  ordinary  rules  of  amendment : 

BY-LAWS. 

First.  The  officers  of  this  Society  shall  be  a President,  Vice-President, 
Secretary,  Treasurer,  and  a Council  of  not  less  than  fourteen  persons, 
including  the  above-mentioned  persons,  the  members  of  the  Council  being 
chosen  to  represent  as  many  of  the  States  as  possible. 


BY-LAWS 


5 


Branch  associations  may  be  formed  in  the  various  States,  and  their 
presidents  shall  be  e%-ojfficio  members  of  the  Council,  and  their  secretaries 
and  treasurers  shall  be  members  of  the  parent  organization. 

The  Council  shall  appoint  such  committees  from  their  own  members,  and 
such  agents  and  officers  of  the  Association  as  the  work  to  be  done  may  require. 
Six  members  of  the  Council  and  thirty  members  of  the  Association  shall  form 
a quorum. 

Second.  Public  meetings  to  awaken  and  increase  a more  general  interest 
in  the  purposes  of  the  Association  shall  be  held  at  such  times  and  places  as 
the  Council  may  appoint ; and  the  Council,  by  the  committee  appointed  among 
their  members,  shall  elect  persons,  who  shall  be  willing  to  accept  the  trust, 
to  prepare  and  read  essays  on  medical  and  social  problems  connected  with 
insanity,  and  such  essays  shall  form  subjects  of  discussion  at  the  meetings 
of  the  Association. 

^T^iird.  Any  person  may  be  a member  of  this  Association  by  paying  two 
i dollars  annually  to  its  Treasurer.  Honorary  members  may  be  elected  by  the 
VCouncil,  who  shall  be  exempt  from  assessments. 

The  Annual  Meeting  of  the  Association,  for  the  choice  of  officers  and  the 
transaction  of  other  business,  shall  be  held  at  such  time  and  place  as  the 
Council  may  appoint,  and  the  same  officers  may  prepare  a code  of  by-laws 
for  carrying  out  and  governing  the  more  specific  details  in  the  operation  of 
the  Society. 

At  this  meeting  the  following  officers  of  the  Association  were  elected: 


H.  B.  Wilbur,  M.D.,  Syracuse,  N.  Y.,  President Nathan  Allen,  M.  D., 
LL.D.,  Lowell,  Mass.,  Vice-President ; Miss  A.  A.  Chevaillier,  Boston, 
Mass.,  Secretary  ; George  JVL  Beard,  M.D.,  New  York,  N.  Y.,  Treasurer. 

There  was  also  elected  a Councif  of  prominent  individuals  of  the  medical, 
legal,  and  other  professions,  representing  many  different  sections  of  the 
country. 

This  Society  already  has  a large  number  of  sympathizers,  including  many 
distinguished  citizens  of  the  different  States.  It  is  desired  to  secure  in  each 
State  some  effective  form  of  governmental  supervision  of  the  insane,  both  in 
and  out  of  the  hospitals  and  asylums,  and  to  promote  a scientific  study  of  the 
subject  in  its  various  aspects  — the  causes,  the  treatment  and  prevention  of 
insanity. 

One  of  the  most  important  of  the  many  questions  to  which  the  Society 
must  give  attention,  is  that  which  relates  to  the  prevention  of  insanity ; and 
in  the  study  of  this  subject,  and  in  the  diffusion  of  sound  information  in 
regard  to  it,  the  cooperation  of  physicians,  both  general  practitioners  and 
specialists  in  the  diseases  of  the  nervous  system,  is  earnestly  invited. 


H.  B.  Wilbur,  M.D.,  Syracuse,  N.  Y.,  President. 

Nathan  Allen,  M.D.,  LL.D.  Lowell,  Mass.,  Vice-President. 

Miss  A.  A.  Chevaillier,  10  Marble  St.,  Boston,  Mass.,  Secretary. 
George  M.  Beard,  M.D.,  13  W.  29th  St.,  New  York,  N.  Y.,  Treas. 


6 


MEMBERS  OF  THE  COUNCIL, 


Members  of  the  Council. 

Prof.  T.  N.  Haskell,  Denver,  Colorado. 

Hon.  Vincent  Colyer,  Rowayton,  Connecticut. 

M.  Abbie  Cleaves,  M.D.,  Davenport,  Iowa. 

A.  Reynolds,  M.D.,  Medical  Sup’t  Insane  Hospital , Independence,  Iowa. 
J.  S.  Jewell,  M.D.,  Chicago,  Illinois. 

J.  C.  Corbus,  M.D.,  Mendota,  Illinois. 

C.  C.  Yemans,  M.D.,  Detroit,  Michigan. 

Joseph  Parrish,  M.D.,  Burlington,  New  Jersey. 

E.  C.  Seguin,  M.D.,  New  York,  N.  Y. 

Mrs.  Benoni  Lockwood,  New  York,  N.  Y. 

Mary  Putnam  Jacobi,  M.D.,  New  York,  N.  Y. 

J.  C.  Shaw,  M.D.,  Medical  Sup’t  Flatlush  Asylum,  Brooklyn,  New  York. 
Hon.  M.  D.  Eollett,  Marietta,  Ohio. 

Hiram  Corson,  M.D.,  Conshohocken,  Pennsylvania. 

Hon.  R.  L.  Lamberton,  Pres’t  Lehigh  TJniv.,  Bethlehem,  Pennsylvania. 
J.  C.  Hall,  M.D.,  Monroe,  Wisconsin. 

Hon,  John  W.  Andrews,  Columbus,  Ohio. 


STATEMENT  OF  THE  NEW  YORK  COMMITTEE. 


In  presenting  his  Paper,  Dr.  Beard  made  the  following  intro- 
ductory remarks : 

“In  the  absence  of  Mr.  Dorman  B.  Eaton,  of  NewYor 
member  of  our  Committee,  Yhave  a double  duty  to  perform, — at 
once  to  state  very  briefly  what  has  been  done  by  this  Committee, 
and  then  to  give  our  plan  for  the  future.  I shall  speak  of  our 
object — the  formation  of  a National  Association  for  the  Protection 
of  the  Insane  and  the  Prevention  of  Insanity  ; but,  first  of  all,  a 
word  in  regard  to  Dr.  Shaw’s  asylum,  which  I visited  a short  time 
since.  I wish  to  speak  in  the  highest  possible  terms  of  that  insti- 
tution. It  is  a noteworthy  fact  that  the  King’s  County  Asylum 
had  a terrible  reputation  ; but  this  young  man  took  hold  of  it  and 
turned  it  from  evil  to  good  in  a short  time.  Rev.  Dr.  Storrs,  of 
Brooklyn,  said  it  was  the  meanest  asylum  under  Heaven.  That 
/was  not  strictly  true,  then,  but  it  is  true  now  that  it  is  one  of  the 
/best  asylums  in  the  world. 

The  Committee,  of  which  I am  a member,  was  appointed  last 
winter  by  George  William  Curtis,  Esq.,  who  was  the  chairman  of 
the  Cooper  Institute  meeting  which  voted  such  a committee,  for 
the  purpose  of  introducing  into  this  country,  so  far  as  possible, 
the  English  system  of  central  governmental  supervision,  that  has 
been  referred  to  this  morning  and  afternoon.  Correspondents  in 
England  with  whom  I was  acquainted,  taking  them  all  as  they 
came,  wrote  to  me  recommending  the  principle  of  supervision  as 
it  has  been  carried  on  in  England  for  years.  The  opinion  of  all 
these  men,  most  of  whom  have  charge  of  asylums,  and  who  were 
under  the  central  Board  of  Lunacy  Commissioners,  to  whom  they 
must  report,  — is  unanimous  that  their  supervision  was  a good 
thing,  and  that  they  would  not  go  back  to  the  old  system  before 
such  a commission  was  formed.  I speak  of  this  because  there  has 
been,  in  some  quarters,  an  opposition.  A bill  was  introduced  in 
the  New  York  Legislature  by  our  Committee,  the  object  of  which 
was  to  form  a Lunacy  Commission  there  by  extending  the  powers 
of  the  State  Board  of  Charities.  The  bill  was  defeated  by  a small 
majority,  largely  through  the  influence  of  a superintendent  of  one 
of  the  State  asylums  in  New  York.” 


WHY  WE  NEED  A NATIONAL  ASSOCIATION  FOR  THE  PROTEC- 
TION OF  THE  INSANE. 

PAPER  READ  JULY  FIRST,  AT  THE  CONFERENCE  OF  CHARITIES  AND  CORREC- 
TIONS, HELD  AT  CLEVELAND,  BY  DR.  GEORGE  M.  BEARD,  AS  A DELEGATE 
TO  THE  CONFERENCE,  AND  REPRESENTATIVE  OF  THE  NEW  YORK  COOPER 
UNION  COMMITTEE  ON  ORGANIZATION  OF  A NATIONAL  ASSOCIATION  FOR 
THE  PROTECTION  OF  THE  INSANE. 

While  passing,  the  other  evening,  through  a collection  of  flowers 
at  an  exhibition  in  New  York,  I observed  a crowd  looking  at  some 
geraniums.  One  who  professed  to  be  skilled  in  these  matters,  told 
me  that  the  object  of  attention  was  a double  white  geranium  which 
had  only  been  developed  within  the  last  ten  or  fifteen  years ; if  it 
existed  before  that  time  it  had  not  been  known  in  this  country,  at 
least  to  horticulture. 

liseases,  like  flowers,  are  developing,  with  each  decade,  new 
phases,  presenting  unheard  of  manifestations,  the  friction  of  our 
civilization.  These  new  diseases,  or  new  phases  of  old  diseases, 
require  new  methods  of  attacking  them.  The  increase  of  diseases 
of  the  nervous  system  (to  which  insanity  in  its  different  forms 
belongs)  is  a phenomenal  and  unprecedented  fact  in  history ; 
neither  in  the  ancient  nor  the  modern  civilization  have  we  any 
analogue  or  comparison  to  the  rise  and  multiplication  of  mental 
diseases,  during  the  past  half  century,  in  Europe  and  in  America. 
The  five  distinguished  characteristics  of  civilization  during  the 
past  half  century  — steam  power,  the  periodical  press,  the  tele- 
graph, the  sciences,  and  the  mental  activity  of  woman  (and  to 
these  one  of  my  critics,  in  the  London  Journal  of  Science,  adds  a 
sixth,  that  is,  the  competitive  examinations) — are  not  only  all 
modern,  but  peculiar  to  this  century,  or,  if  they  existed  before,  it 
was  in  embryo  only.  The  competitive  examinations  of  the 
Greeks  were  for  skill  and  excellence  in  muscular  feats,  and  in 
their  great  processions,  it  is  said,  the  places  of  glory  were 
awarded  to  those  who  were  victorious  in  the  games  that  required 
physical  strength  and  training.  The  general  worship  of  the  intel- 
lect is  all  modern.  For  all  these  supreme  advantages  we  must  pay 
the  full  price,  part  of  which  is  insanity  and  the  nervous  diseases 
of  the  family  to  which  insanity  belongs,  and  societies  like  this  that 
is  now  to  be  organized. 

Not  only  have  new  forms  of  insanity  arisen,  but  the  actual  num- 
ber of  the  insane  and  the  relative  numbers  to  the  population,  are 


PAPER  BY  DR.  GEORGE  M.  BEARD. 


9 


much  greater  than  fifty  years  ago ; both  in  quantity  and  in  quality 
there  has  been  an  evolution.  New  York  is  a great  city,  but  the 
prospective  insane  population  of  this  country  must,  in  time,  be  far 
greater  than  that  of  New  York  at  present.  The  armies  that  on 
both  sides  fought  the  war  of  the  rebellion  were  enormous,  but  the 
army  of  the  insane  of  the  future  is  more  likely  to  be  greater  than 
aller.  This  continent  is  to  be  the  home  of  five  hundred  millions, 
if  not  double  that  number,  and  unless  forces,  that  we  cannot  now 
suspect,  much  less  control,  appear  to  our  rescue,  one  out  of  every 
three  hundred  of  this  republic  will  be  insane.  At  the  time  of  the 
Declaration  of  Independence  there  was  in  these  colonies  a popula- 
tion of  three  millions  ; it  is  not  wild  to  surmise  that  in  the  coming 
centuries  there  should  be  half  of  three  millions  insane  in  this 
republic. 

This  augmentation  of  the  numbers  of  the  insane,  and  this 
development  of  novel  symptoms  and  forms  of  insanity,  are  most 
notably  seen  among  the  English  speaking  people.  Insanity  is  a 
part  of  the  cost  of  liberty ; it  is  a tax  on  our  freedom,  that  so 
many  must  be  deprived  of  their  freedom.  In  the  great  despot- 
isms there  is  little  need  of  societies  for  the  protection  of  the 
insane  ; where  the  sane  are  all  oppresed,  the  number  of  the  insane 
has  never  been  very  great.  The  Czardom  of  Russia  oppresses  its 
subjects,  but  does  not  make  them  crazy,  and  the  Turks,  with  all 
their  weaknesses,  are  mostly  sane.  England,  the  spawning  ground 
of  empires,  sends  out  her  children  through  all  the  earth,  carrying 
with  them  the  seeds  both  of  liberty  and  nervous  disease,  ^iberty 
implies  responsibility ; responsibility  leads  to  worry,  and  worry 
is  attended  always  with  disappointment.  Out  of  the  throes  and 
agonies  and  manipulations  and  calculations  of  the  last  month,  two 
men  have  been  nominated  for  the  supreme  office  of  this  nation,  to  the 
disappointment  of  thousands  upon  thousands  of  candidates,  their 
followers  and  friends.  A solid  despotism  and  established  religion 
are  partly  redeemed  byTEfs  — that  they  "keep  the  asyhiffiFnTiTpty  ; if 
"we  think  for  ourselves  and  govern  ourselves,  thousands  must  go 
down  in  the  struggle.  Nature  knows  nothing  of  disinterested 
benevolence  ; she  never  gives  anything  ; she  may  often  trust  for  a 
time,  but  sooner  or  later  we  have  got  to  pay,  principle  and  interest. 

As  a philosopher  has  said,  all  progress  is  in  waves — >a  motion  i? 

without  any  advance. 

The  peculiar  helplessness  of  the  insane  is  a third  and  self- 
asserting  reason  for  the  formation  of  organizations  for  their  pro- 


10  NATIONAL  ASSOCIATION  FOR  PROTECTION  OF  THE  INSANE. 


tection.  We  have  societies  for  the  prevention  of  cruelty  to 
children,  but  the  insane  are  children  without  their  naivete , their 
innocence  or  their  sweetness  ; we  have  societies  for  the  prevention 
of  cruelty  to  animals,  but  insanity  oftentimes  reduces  man  below 
the  grade  and  habits  of  the  lowest  animal ; we  have  societies  for 
relieving  the  condition  of  the  poor^lmTlnganity"  makes  us  poor, 
while  poverty  makes  us  insane  ; we  have  associations  for  the  care 
of  criminals  and  the  amelioration  of  prisons,  but  the  insane  have 
oftentimes  a worse  than  criminal's  punishment,  without  his  crime. 
We  have  health  boards,  local  and  national,  for  the  warding  off  of 
fatal  epidemics,  but  death,  even  at  the  hands  of  the  foulest 
disease,  is  poetry  compared  with  hopeless  disease  of  the  mind. 
Most  of  the  evils  of  this  world  can  be  relieved,  even  when  not 
cured,  by  money  ; as  Richter  puts  it,  “ To  a shower  of  gold  most 
things  are  easily  penetrable ; ” but  the  possession  of  money  is 
sometimes  the  very  temptation  for  the  charge  of  insanity  by 
interested  heirs. 

A fourth  reason  why  this  society  should  exist  is,  that  it  may 
help  to  bring  about  the  principle  of  central  governmental  super- 
vision of  the  insane,  in  or  out  of  the  asylums,  through  all  the 
States  of  this  Republic.  More  and  more,  each  year,  matters  of 
minor  import  are  becoming  the  objects  of  systematic  official  super- 
vision ; our  banks,  our  insurance  organizations,  our  churches  and 
schools,  our  institutions  of  charity,  are  subordinate  to  some  cen- 
tral authority,  or  authorities  ; only  the  insane,  and  they  who  care 
for  them,  are  left  wholly  to  themselves,  in  some  States.  Central 
governmental  supervision,  when  carried  out  in  this  country,  as  for 
more  than  thirty  years  it  has  been  carried  out  in  Great  Britain, 
will  give  assurance  to  the  friends  of  sufferers,  and  to  the  people, 
that  the  insane  in  asylums,  public  and  private,  and  at  their  homes, 
are  treated  wisely  and  kindly. 

Central  supervision  will  prevent  outrageous  cruelty,  and  the 
incarceration  and  imprisonment  of  the  sane ; central  supervision 
will  aid  those  who  seek  homes  for  unfortunates  in  finding 
precisety  the  institutions  that  they  need  ; central  supervision  will 
help,  among  other  forces,  to  elevate  the  standard  of  scientific 
study  on  all  the  great  questions  relating  to  insanity  — theoretical 
and  practical ; finally,  central  supervision  will  protect  the  officers 
and  managers  of  asylums  themselves,  who  now  stand  right  in 
range  of  artillery  which  is  directed  upon  them  from  every  quarter, 


PAPER  BY  DR.  GEORGE  M.  BEARD. 


11 


and  against  the  assaults  of  which  they  themselves  are  powerless. 

If  asylums  were  perfect,  they  could  not  prove  themselves  such  to 
the  satisfaction  either  of  the  people  or  of  the  medical  profession ; 
if  your  friend  is  confined  in  any  institution,  and  is  treated 
judiciously  and  treated  scientifically,  you  have  no  way  of  knowing 
that  fact.  In  this  most  delicate  of  all  questions  we  must  walk  by 
faith. 

Another  reason  for  the  existence  of  such  a society  as  this,  is  the 
necessity  of  raising  the  standard  of  thought  and  of  treatment  of 
the  insane,  both  in  and  out  of  asylums.  In  no  branch  of  science 
has  there  been,  on  the  whole,  progress  more  satisfactory,  or  more 
jrapid,  or  more  widely  diffused,  during  the  past  t wenty^ears , _th ah 
in  the  study  and  management  of  diseases  of  theTnervous  system  ; 
and  of  this  progress  the  insane  everywIrere--^ttghirto~imftalre'^aT — 
more  freely  than*  they  do  now.  You  say  that  this  advance  should 
be  led  wholly,  and  controlled  exclusively,  by  students  - of  the  ner- 
vous system,  but  this  is  a matter  in  which  every  boot-black  has  an 
interest.  The  questions  of  insanity  are  not  exclusively  confined 
to  experts  in  the  nervous  system ; politics  come  in,  since  the 
insane  become  wards  of  the  State,  and,  in  this  country,  politics 
means  the  people  who  make  the  laws,  and  men  of  science  must 
partly  work  with  and  through  the  people,  if  they  would  advance  this 
subject.  Laws,  among  English-speaking  people,  are  results  more 
than  causes  ; legislators  are  servants,  waiting  on  the  table  of  the 
nation,  and  give  us  what  they  are  ordered  ; they  do  not  have,  and  are 
not  expected  to  have,  any  thoughts  or  suggestions  beyond  the  will 
of  their  constituents.  If  any  of  the  asylums  are  not  as  they 
should  be,  if  too  much  money  is  given  for  the  buildings  and  too 
little  for  the  medical  officers,  if  assistance  is  meagre  and  bad,  if 
there  is  lack  of  accommodation,  the  people  are  the  ones  to  be 
blamed ; the  people  are  the  persons  to  be  addressed,  and,  so  far 
as  public  institutions  are  concerned,  only  the  people  can  bring  the 
remedy.  These  are  questions  of  knowledge,  of  confidence,  and  of 
money  ; and  the  money  will  not  come  until  it  has  been  preceded 
both  by  knowledge  and  by  confidence.  You  say  “ the  asylums,  the 
chiefs  of  asylums,  and  the  national  Association  of  Asylum 
Superintendents,  should  do  this  work,”  but  this  is  not  their  busi- 
ness, and,  were  it  so,  they  would  be  unequal  to  it.  The  force  that 
makes  the  body  grow  comes  from  outside  the  body  ; the  elements 
that  make  a civilization  must  come,  in  part,  from  outside  the  race 


12  NATIONAL  ASSOCIATION  FOR  PROTECTION  OF  THE  INSANE. 


that  is  civilized.  If  we  had  waited  for  jailers  to  reform  the  jails, 
or  for  prisoners  themselves  to  organize  a prisoners’  association, 
or  for  our  infants  to  have  led  the  way  in  the  formation  of  the 
society  for  the  prevention  of  cruelty  to  children,  or  for  domestic 
animals  to  have  inaugurated  institutions  to  keep  them  from  being 
treated  cruelly,  we  should  not  have  been  more  unwise  than  to 
wait  for  asylums,  their  officers,  their  managers  or  their  inmates, 
to  lead  and  control  the  advance  which  is  now  being  made  in  the 
study  “and  treatment  of  insanity.  In  this  rising  flood  of  nervous 
diseases,  asylums  are  themselves  submerged  and  helpless,  like 
unfortunate  villages  surprised  by  mountain  torrents,  and  all  who 
have  strength  should  come  to  the  rescue. 

The  subject  of  insanity  is  greater  than  asylums ; it  is  greater 
than  all  institutions,  public  or  private,  that  have  been  organized  to 
meet  and  overcome  this  great  evil.  Asylums  are,  to  the  general 
subject  of  insanity,  what  hospitals  in  war  are  to  the  great  battles 
going  on  in  the  front ; they  but  receive  those  who  have  fallen  in  the 
ranks,  and  are  to  keep  in  the  rear,  while  the  lines  of  battle  are  far 
in  advance  and  outside  of  them.  The  subject  of  insanity  is  greater 
than  insanity  itself,  since  all  the  diseases  of  the  brain  and  the  nerve 
system,  by  whatsoever  names  known,  are  related  to  each  other, 
run  into  each  other,  and  take  each  other’s  place.  The  man  who 
only  knows  insanity,  does  not  know  even  that ; all  the  diseases  of 
the  nervous  system  are  members,  one  of  another,  and  are  to  be 
studied  as  parts  of  a great  whole  and  in  relation  to  each  other. 
More  and  more  I am  persuaded,  in  the  study  of  my  cases  of 
neurasthenia,  or  nervous  exhaustion  and  allied  states,  that  insanity, 
in  the  parent  or  grandparent,  may  appear  in  the  offspring,  near  or 
remote,  not  as  insanity,  but  in  some  milder  form  of  neurosis,  of 
which  neurasthenia  is  a type  and  centre.  I have  thought  that,  in 
this  way,  one  of  the  problems  of  insanity  is  solving  itself;  that 
there  is  a tendency  to  self-cure  running  through  the  generations, 
perhaps  with  increasing  mildness  of  nerve  trouble  in  the  place  of 
increasing  severity,  and  that  possibly,  in  some  families,  there  would 
be  in  the  next  generation  less  nervousness  than  now. 

A sixth  mission  of  this  society  will  be  to  obtain  from  every 
source,  and  diffuse  through  all  ranks  of  intelligent  society,  a 
knowledge  of  all  the  branches  of  the  subject.  That  insanity,  for 
example,  is  a disease  of  the  nervous  system,  and  a physical  disease, 
as  much  as  small-pox  or  a broken  leg,  is  a truism  among  neuralo- 


PAPER  BY  DR.  GEORGE  M.  BEARD. 


13 


gists,  but  it  is  not  a truism  among  the  people.  Like  witchcraft, 


like  astrology,  like  alchemy,  the  delusion  that  disease  of  the  mind 
is  something  separate  from  the  body,  lingers  all  along  our  hillsides 
and  in  the  valleys,  and  even  on  the  mountain  tops  of  our  civiliza- 
tion ; men  run  from  an  insane  person  as  from  one  possessed  of  an 
evil  spirit.  This  society  will  have  justified  its  existence  if  it  shall 
succeed  in  doing  nothing  hut  this  — in  obtaining  universal  recognition 
of  the  fact  that  it  is  no  disgrace  to  he  crazy.  Through  all  the 
avenues  of  information  we  are  to  seek  for  light  on  this  problem, — 
how  to  prevent  insanity,  how  to  reduce  to  a minimum  the  friction 
of  modern  life.  The  London  critic,  to  whom  I have  referred, 
reminds  us  that,  when  the  steam  engine  was  introduced,  it  was 
supposed  it  would  do  all  the  work  of  the  world  and  allow  us  to  be 
idle ; whereas,  it  has  increased  the  world’s  work,  and  helped  to 
increase  nervous  disease.  This  society  will  have  justified  its 
existence  if  it  shall  succeed  in  making  it  no  longer  discreditable  to 
be  manfully  idle.  A century  ago,  the  problem  was  how  to  make 
everybody  work ; today,  the  problem  is  how  to  keep  people  from 
overworking ; the  children  of  the  last  generation  were  goaded  and 
spurred  into  study  ; the  children  of  this  generation  must  be  checked 
and  restrained  — kept  back  — held  in  from  study.  The  details  of 
the  reform  which  is  now  beginning  in  the  methods  of  education, 
belong  in  part  to  this  society.  We  must  give  up  either  our  sanity 
or  our  schools,  as  man}*-  of  them  are  now  managed.  The  whole 
English  speaking  race  is  facing  the  problems  that  are  offered  to 
this  society  ; in  England,  even  more  than  this  country,  at  this  very 
hour  all  these  questions  are  raised  and  asked,  and  pressed  with 
more  force  and  persistence  than  here. 

I close  with  three  or  four  suggestions  of  a general  character, 
that  will  apply  not  only  to  this  organization,  but  to  all  organiza- 
tions that  have  for  their  object  the  well-being  of  mankind. 


First  of  all,  we  should  beware  of  unintelligent  philanthropy, 


is,  doing  good  at  short  range,  relieving  present  evils  by  increasing 


those  that  are  to  come.  No  form  of  human  energy  so  often  fails  in 
its  purpose  as  philanthropy.  Among  the  wisest  words  ever  uttered 
are  these:  “Charity  creates  much  of  the  misery  that  it  relieves, 
but  it  does  not  relieve  all  the  misery  that  it  creates.”  Philanthropy 
in  excess  becomes  cruelty,  and,  with  a force  and  success  that  no 
tyrant  can  rival,  heightens  and  deepens  the  miseries  of  mankind ; 
doing  good  is  easily  turned  to  doing  evil,  and  present  distresses, 


14  NATIONAL  ASSOCIATION  FOR  PROTECTION  OF  THE  INSANE. 


when  relieved,  but  enrich  the  soil  out  of  which  other  and  more  ter- 
rible distresses  are  to  arise.  Talking  on  this  subject  the  other  day 
with  one  of  our  best  known  philanthropists,  who  for  years  has 
given  largely  and  freely,  — Mrs.  Elizabeth  Thompson,  of  New 
York,  — I asked  her  if  her  experience  confirmed  my  scientific 
deductions  that  philanthropy  was  too  often  a mistake.  She 
said,  u Yes,  it  has  taken  me  all  my  life  to  learn  this.  I can  but  feel 
that  I have,  on  the  whole,  done  more  evil  than  good  in  what  I have 
given  away.  I have  denied  myself  to  give  to  others  ; to  find,  in 
return,  not  only  ingratitude,  but  failure.  I see  no  way  of  helping  the 
poor  but  to  make  the  poor  help  themselves.”  Philanthropy  is  not 
wise  in  attempting  to  walk  alone ; she  needs  the  support,  on  the 
one  hand,  of  science,  on  the  other,  of  philosophy. 

A second  suggestion  is,  that  we  do  not  depend  too  much  on  law. 
Even  in  a monarchy,  laws  cannot  be  very  far  ahead  of  the  people, 
and  in  a republic  they  are  but  the  expressions  of  the  wishes  or 
fancies  of  the  majority.  The  enacting  of  laws,  therefore,  even 
those  most  necessary  and  imminent,  as  those  that  relate  to  the 
central  governmental  supervision  of  the  insane,  may  be  among  the 
last  stages  in  this  advance  on  the  subject  of  insanit}7-.  We  are  in 
the  habit  of  running  to  the  law  and  burying  our  heads  in  it,  and 
cr}7ing  like  children,  whenever  we  are  in  trouble,  forgetting  that 
legislators  are  themselves  but  children,  whom  we,  the  people,  are 
to  educate  and  command.  The  principle  of  central  supervision  of 
the  insane  by  government  is  to  prevail  on  this  continent  from  the 
Atlantic  to  the  Gulf,  but  not  until  thousands  of  messages  have  gone 
forth  among  the  people,  as  so  many  school-masters,  to  train  them 
to  desire  and  ask  for,  and  appreciate,  such  legislation. 

Finally,  we  are  not  to  look  for  the  completion  of  our  labors  as 
soon  as  they  are  begun.  All  nature  is  but  a process  of  preparation  ; 
results  are  but  means  to  higher  results  ; nothing  is  final  and  com- 
plete ; what  we  call  preparation  may  be  far  more  useful  than  the 
end  for  which  we  prepare. 

In  all  organisms,  each  layer  of  growth  is  the  pathway  for  a higher 
growth  ; our  very  reformations  need  themselves  to  be  reformed,  and 
the  consummate  issue  ma}T  flash  out  suddenly  after  long  and  hopeless 
delay.  We  bury  the  seed,  the.  plant  breaks  through  the  surface,  a 
huge  trunk  is  developed  that  sends  its  branches  farther  and  higher, 
and  clothes  itself  with  richer  and  richer  foliage,  year  by  }Tear,  and  the 
buds  appear  ; but,  as  yet,  no  fruit  or  flower  ; we  go  away  for  a night, 
and  on  our  return  our  barren  tree  is  alive  and  eloquent  with  blossoms. 


PAPER  BY  DR.  GEORGE  M.  BEARD. 


15 


In  these  United  States  of  America,  it  requires  on  the  average 
from  five  to  fifteen  years  for  a new  and  unpopular  truth,  if  it  have 
practical  relations,  and  be  wisely  engineered,  to  become  old  and 
popular.  Those  whose  faith  will  allow  them  to  wait  for  a decade, 
will  see  this  movement,  begun  in  doubt  and  gloom,  pass  into  and 
through  the  early  twilight  into  the  clearness  and  glorj7  of  the 
morning. 


SPECIAL  SESSION  ON  LUNACY. 
Thursday  Afternoon,  July  1. 


The  President,  at  the  opening  of  this  Session,  said  that  it  was 
held  for  the  purpose  of  hearing  what  a committee  from  New'York, 
represented  by  Dr.  G.  M.  Beard,  Dr.  E.  C.  Seguin  and  Miss  A. 
A.  Chevail'lier,  have  to  present  in  respect  to  the  important  subject 
of  lunacy.  He  then  introduced  Dr.  Seguin,  who  read  the  follow- 
ing paper : 

THE  PRACTICABILITY  AND  VALUE  OF  NON-RESTRAINT  IN 
TREATING  THE  INSANE. 

PAPER  READ  JULY  FIRST,  AT  THE  CONFERENCE  OF  CHARITIES  AND  CORREC- 
TIONS, HELD  AT  CLEVELAND,  BY  DR.  J.  C.  SHAW,  AS  A DELEGATE  TO  THE 
CONFERENCE,  AND  REPRESENTATIVE  OF  THE  NEW  YORK  COOPER  UNION 
COMMITTEE  ON  ORGANIZATION  OF  A NATIONAL  ASSOCIATION  FOR  THE 
PROTECTION  OF  THE  INSANE. 


Mr.  Chairman , Gentlemen  and  Ladies:  — I am  not  here  to  pre- 
sent to  you  an  historical  sketch  of  the  subject  of  non-restraint  in 
the  management  and  care  of  the  insane,  but  to  direct  your  atten- 
tion briefly  to  the  practical  part  of  the  subject ; and  to  demonstrate 
that  it  is  practicable  and  beneficial,  observations  have  been  made 
in  the  King’s  Count}*  Insane  Asylum,  which  is  under  my  direction. 
f Several  papers  have  been  presented  to  this  Conference  at  its  meet- 
ly ings  during  the  past  six  years,  some  treating  the  subject  pretty 
N exhaustively.  Among  them  are  the  papers  by  Dr.  H.  B.  Wilbur, 
Dr.  J.  L.  Bodine  and  Mr.  F.  H.  Wines.  There  are  also  papers 
by  Drs.  Folsom  and  Bucknill  on  asylums  in  America,  to  all  of 
which  I refer  you. 

On  taking  charge  of  the  asylum,  not  two  years  ago,  I found  a 
large  number  of  patients  in  restraint-jackets,  straps  and  seclusion. 
On  inquiring  why  certain  male  patients  were  in  restraint,  I was 
told  by  the  attendants  and  the  assistant  physician,  who  was  then 
in  charge  of  the  wards,  that  they  were  bad,  vicious  patients,  who 
would  injure  the  nurses  and  other  patients.  Some  of  these 
patients  had  been  in  restraint  for  months,  and  even  for  years. 
On  considering  the  situation  of  things,  and  the  best  way  of 
reducing  this  very  high  ratio  of  restraint,  I observed  that  the 
patients,  whenever  they  were  in  the  presence  of  the  attendants, 
showed  by  the  expression  of  their  faces  evident  dislike  to  them  ; 
and,  as  the  nurses  stoutly  insisted  that  these  patients  could  not  get 


PAPER  BY  DR.  J.  C.  SHAW. 


17 


along  without  restraint,  I saw  that  if  I took  the  apparatus  off  in  these 
halls,  and  with  these  nurses,  I should  certainly  be  unsuccessful,  as 
there  soon  would  be  a collision  between  the  patients  and  their 
nurses.  I therefore  removed  the  patients  into  other  halls,  with 
nurses  comparatively  strangers  to  them,  and  then  took  the 
apparatus  off.  This  proved  to  be  a complete  success,  and 
patients  who  had  been  in  continued  restraint,  night  and  day,  for 
^ /fhonths,  and  even  for  years,  now  got  along  so  quietty  that  I some- 
( times  wondered  why  they  had  ever  been  put  in  restraint  at  all. 
\£he  restraint  on  the  female  side  was  less  than  on  the  male  side, 
and  this  was  due  to  the  greater  intelligence  of  the  assistant  in 
charge.  Here  also  we  adopted  the  same  plan,  with  like  success. 
Simultaneously  all  the  restraint  apparatus  was  taken  from  the 
halls  where  previously  it  had  been  kept  (for  the  nurses  to  apply  at 
their  discretion),  to  the  office,  so  that  it  could  only  be  applied  by 
direction  of  the  medical  staff ; the  restraint  to  be  for  such  a length 
of  time  as  they  directed,  and  then  returned  to  the  office  and  a 
record  kept  of  it.  In  this  way  we  reduced  the  restraint  to  about 
five^iatients  in  700.  This  proved  to  be  so  successful  and  satisfac- 
tory to  all  the  staff,  as  well  as  to  myself,  that  I determined  to  have 
no  restraint  apparatus  at  all,  for  then  none  could  be  used.  So  I 
had  it  all  burnt,  and  I do  not  exaggerate  when  I say  that  there 
must  have  been  three  hundred  pairs  of  restraint  apparatus,  straps, 
camisades,  etc. 

The  only  thing  that  now  could  be  used  was  seclusion,  and  this 
was  strictly  watched,  and  its  use,  without  permission,  made  an 
offence  punishable  by  dismissal ; hence,  we  had  little  use  made  of 
it.  I must  speak  of  one  woman  on  whom  we  bestowed  much 
thought.  She  is  very. large,  tall  and  stout,  weighing  at  least  two 
jitmdred  and  fifty  pounds  ; she  had  been  in  seclusion  for  years,  and 
! her  food  was  handed  in  to  her ; she  was  at  times  a very  quiet 
j patient,  and  at  others  violent ; she  was  in  the  charge  of  a good 
^ nurse,  who  used  to  take  her  out  in  the  evening,  when  she  was 
fjuiet,  and  allow  her  to  walk  up  and  down  the  hall ; she  would 
strike  other  patients  if  she  became  angry,  and,  from  her  size,  was 
quite  a terror.  My  assistant,  Dr.  Arnold,  was  determined  to  find 
a way  of  keeping  her  out  in  the  hall  with  the  rest  of  the  patients. 
She  had  been  in  seclusion  so  long  that  it  really  became  a matter 
of  judicious  management  how  to  have  her  out  associating  with  the 
other  patients,  and  have  no  continued  quarrels  and  fights ; but  at 
2 


18  NON-RESTRAINT  IN  TREATING  THE  INSANE. 


last  he  succeeded,  and  now  she  moves  about  the  hall  with  the  other 
patients,  and  dines  in  the  associated  dining-room. 

I must  now  beg  you  to  consider  what  has  been  accomplished 
under  great  disadvantages  : as  is  well  known,  county  asylums  have 
far  less  facilities  than  State  asylums.  We  have  over  700  patients, 
on  an  average  one  attendant  to  15  patients,  no  grounds  to  speak 
of,  except  an  airing  court ; and  a comparatively  low  diet.  This 
system  of  non-restraint  is  of  the  best  possible  effect  on  the 
patients ; they  are  less  violent  and  more  contented.  We  do  not 
/find,  as  has  been  alleged,  I believe,  that  it  is  more  irritating  to 
the  patients  to  be  under  the  control  of  the  attendants  than  it  is  to 
have  the  apparatus  on  them,  but  just  the  reverse.  Patients  dislike 
very  much  to  be  tied  up  in  any  kind  of  apparatus ; if  the  attend- 
ants treat  them  courteously  and  with  consideration,  but  with 
firmness,  there  need  be  no  ill  feeling  or  resentment  on  the  part  of 
patients.  A great  deal  can  be  accomplished  without  force.  As 
soon  as  we  find  that  a patient  takes  a dislike  to  a nurse,  and  cannot 
get  along  with  him  or  her,  we  remove  the  patient.  We  find  that 
since  the  abolition  of  the  restraint  we  hear  and  see  less  of  violent 
patients  than  we  did  with  the  restraint ; and  we  certainly  have 
fewer  scuffles  between  patients  and  attendants,  and  no  more 
instances  of  patients  hitting  each  other  than  we  had  when  it  was 
in  vogue. 

Now,  as  to  how  this  system  is  to  be  carried  out  in  any  asylum ; 
and,  if  you  please,  let  us  take  an  asylum  under  the  worst  possible 
circumstances,  and  containing  a great  many  patients.  It  has  been 
said  by  an  expert  German  psychologist  and  neurologist,  that  when 
the  non-restraint  system  was  introduced  into  the  Charite-Kran- 
kenliaus  at  Berlin,  every  attendant  had  to  be  dismissed  ; I hardly 
think  this  would  be  necessary  in  America,  but  if  it  were,  why,  let 
us  do  it.  I here  quote  a passage  from  the  paper  of  Dr.  Bodine : 
-“  The  attendant,  is.  the  weak  point  in  the  non-restraint  system; 
The  natural  impulse  of  fhe  'aTerage  attendants  to  treat  the 
patients  entrusted  to  his  care  ‘ like  dumb,  driven  cattle,’  but  well 
chosen  attendants,  being  treated  by  their  superior  officers  with 
kindness,  consideration  and  humanity,  will  thus  be  prepared  to 
extend  the  same  law  of  human  kindness  to  their  afflicted  and  often 
perverse  charges.  The  superintendent  always  gives  tone  to  his 
whole  institution,  and  the  insane  unconsciously  assimilate  the 
character  of  their  surroundings  and  associations  very  much  as 


PAPER  BY  DR.  J.  C.  SHAW. 


19 


children  do.  The  attendant  will  never  be  more  careful  and  con- 
siderate of  the  interests  and  welfare  of  the  patients  than  his 
superior  officers  are.”  This  is  a correct  statement  of  the  relation 
of  the  officers  to  the  attendants  and  patients. 

I did  not  find  it  necessary  to  dismiss  any  of  my  attendants  to 
carry  out  the  non-restraint  plan,  but  they  were  given  to  understand 
that  it  had  to  be  carried  out,  and  no  harshness  would  be  tolerated  ; 
and  they  were  closely  supervised.  Attendants,  as  a rule,  will  very 
soon  do  what  they  find  the  superintendent  intends  to  carry  out,  with- 
out vacillation.  One  thing  is  absolutely  necessary,  however,  and  it 
is  that  the  assistant  medical  officers  should  be  in  entire  accord  with 
the  superintendent;  in  this  I have  been  most  fortunate.  Dr. 
John  Arnold  and  Dr.  John  S.  Woodside,  my  two  senior  assistants, 
have  been  just  as  anxious  and  zealous  in  carrying  it  out  as  I have 
been  myself,  and  to  them  a great  deal  of  credit  is  due. 

/ Closely  connected  with  this  matter  of  non-restraint  is  the 
employment  of  patients ; these  two  go  together.  The  employment 
of  patients  means  the  abolition  of  restraint  apparatus ; the  plan 
\pf  keeping  patients  day  after  day  and  month  after  month  in  a 
hall,  is,  in  my  judgment  and  observation,  highly  detrimental  to 
their  mental  health  ; even  the  demented  become  more  stupid  under 
these  circumstances.  With  the  limited  ground  and  facilities  at  my 
command,  I have  been  able  to  do  comparatively  little  in  my  asylum, 
but  I hope  and  believe  it  will  compare  well  in  this  with  other 
asylums  having  ampler  facilities  and  grounds.  I succeeded  in 
having  placed  at  my  disposal  about  sixteen  acres  of  garden.  On 
this  we  have  occupied  many  of  our  male  patients,  whilst  others 
made  roads,  etc.  The  non-restraint  and  occupation  of  patients 
are,  in  our  experience,  most  efficient  means  of  treatment.  Patients 
who  appeared  almost  hopelessly  insane,  recovered  while  out  of 
doors  working ; others  recovered  much  faster  than  they  otherwise 
would  have  done. 

At  first  a number  of  patients  ran  away,  but  after  a while,  as 
they  became  more  accustomed  to  being  out  and  had  more  freedom, 
the  runaways  became  less  and  less.  The  patients  like  to  go  out, 
and  they  ask  to  be  allowed  to  do  so ; of  course,  a few  refuse  to 
do  anything.  The  employment  of  women  is  more  difficult,  as  we 
cannot  so  easily  give  them  the  outside  work,  in  the  way  of  garden- 
ing, that  we  do  men ; sewing,  housework  and  employment  in  the 
laundry  are  mostly  the  occupations  that  they  can  engage  in. 


20 


NON-RESTRAINT  IN  TREATING  THE  INSANE. 


From  what  I have  seen  of  this  increased  freedom  among  our 
patients,  I am  convinced  that  a great  deal  of  freedom  can  be 
allowed  them,  and  I do  not  think  that  it  is  at  all  exaggerated  by 
the  English  and  Scotch  superintendents.  I have  become  more  and 
more  convinced  that  the  occupation  of  these  patients  is  a most 
important  element  in  treatment,  and  in  the  happiness  of  those  who 
are  incurable.  Had  I the  ground  that  surrounds  some  of  the  State 
asylums  I could  get  almost  every  one  of  my  patients  out  to  work. 
I am  sure  that  a great  deal  can  be  done  with  a short  allowance  of 
attendants ; this  need  be  no  excuse ; there  are  many  patients  in 
every  asylum  who  are  almost  as  good  as  nurses,  and  will  help  to 
keep  the  others  in  order. 

I regret  very  much  that  there  is  such  a lack  of  public  confidence 
in  asylum  management.  This,  I am  convinced,  plays  a.  certain 
part  in  obstructing  the  progress  of  changes.  I mean  the  ill  feeling 
which  is  entertained  by  ignorant  persons.  I do  not  mean  intelli- 
gent criticism,  but  the  ignorant  friends  and  relatives  of  patients 
in  asylums  — these,  I say,  are  obstructions  to  improvements.  I 
believe  I do  not  speak  unadvisedly ; for  instance,  I have  had 
persons  make  complaints  and  tirades  against  me  because  I 
employed  patients  in  gardening  and  other  out-of-door  work.  In 
one  instance  the  aunt  of  a young  man  was  highly  indignant 
because  her  nephew  worked  in  a garden,  and  she  demanded  that 
he  should  be  removed  from  the  work.  The  young  man  was  sent 
to  his  work  at  his  own  request.  When  he  was  sent  for  and  asked 
if  he  wished  to  remain  in  the  hall  where  he  was  and  continue  to 
work  in  the  garden,  or  be  sent  back  to  the  hall  he  was  in  before, 
he  said  that  he  did  not  wish  to  be  moved.  His  aunt  then  pro- 
tested that  he  was  nothing  but  an  insane  boy  and  did  not  know 
what  was  good  for  him,  lamented  that  he  was  all  sunburnt,  and 
said  that  he  had  no  business  to  work,  and  she  would  see  about  it. 
I,  of  course,  gratified  the  young  man,  and  positively  refused  to 
change  him ; he  was  in  a hall  where  the  door  was  always  open, 
and  he  could  go  in  and  out  as  he  pleased.  At  another  time,  the 
'grand  jury  of  the  county  inquired  of  a judge  if  they  could  indict 
a superintendent  for  making  insane  persons  work.  Now,  it 
requires  some  courage  on  the  part  of  superintendents  to  change 
the  old  routine  under  this  kind  of  tyranny  and  interference ; a 
man  who  is  timid,  yields  rather  than  subject  himself  to  this  and 
similar  annoyance ; but  he  who  does  so  must  be  a man  who  has 


PAPER  BY  DR.  J.  C.  SHAW. 


21 


little  feeling  for  his  patients,  and  is  satisfied  to  go  through  his 
halls  and  see  them  as  prisoners,  rather  than  unfortunate  creatures 
needing  care  and  kindness.  It  becomes  the  duty  then,  in  my 
opinion,  of  such  bodies  as  this,  and  other  philanthropic  bodies  and 
individuals,  to  instil  into  the  public  mind  the  importance  of  a 
change  in  the  present  system  of  keeping  the  patients  shut,  up, 
which  is  almost  universally  done  in  American  asylums.  Patients 
in  asylums  are  not  half  as  insane  as  some  persons  suppose  them 
to  be ; a great  deal  can  be  trusted  to  most  of  them,  and  a greater 
amount  of  liberty  allowed  them. 

This  very  brief  communication  is  brought  before  this  Conference 
to  prove  that  the  non-restraint  system  is  quite  practicable  in 
America,  notwithstanding  the  opposite  has  been  stated. 


THE  RIGHT  OF  THE  INSANE  TO  LIBERTY. 


PAPER  READ  JULY  FIRST,  AT  THE  CONFERENCE  OF  CHARITIES  AND  CORREC- 
TIONS, HELD  AT  CLEVELAND,  BY  DR.  E.  C.  SEGUIN,  AS  A DELEGATE  TO  THE 
CONFERENCE,  AND  REPRESENTATIVE  OF  THE  NEW  YORK  COOPER  UNION 
COMMITTEE  ON  ORGANIZATION  OF  A NATIONAL  ASSOCIATION  FOR  THE 
PROTECTION  OF  THE  INSANE. 

“The  true  principle  to  guide  our  practice  should  be  this,  — that  no  one, 
sane  or  insane,  should  ever  be  entirely  deprived  of  his  liberty,  unless  for  his 
own  protection  or  for  the  protection  of  society.”  Henry  Maudsley. 

It  is  fair  to  say  that  in  the  present  state  of  psychiatry  in 
America,  to  be  pronounced  insane  by  physicians,  by  a judge,  or  by 
a jury,  means  imprisonment  for  months,  for  years,  or  for  life.  To 
put  it  in  another  way,  there  is  a disease  which  reduces  its  victims 
to  a level  with  persons  accused  of  crime,  and  exposes  them  to  loss 
of  liberty,  property  and  happiness. 

Is  this  just?  Is  this  worthy  of  a country  like  ours,  which  aims 
to  be  foremost  in  works  of  philanthropy,  and  preeminent  as  regards 
individual  liberty  ? 

Let  us  review  the  facts  of  medico-legal  practice  in  the  State  of 
New  York,  on  which  these  statements  rest. 

1.  A man  has  acute  mania,  he  becomes  unmanageable  at  home, 
is  dangerous  to  himself  and  to  others.  This  man  is  summarily 
placed  in  a carriage,  taken  to  an  asylum  and  locked  in,  without  any 
process  of  law.  Before  a certain  time  has  elapsed  after  his  recep- 
tion (five  days),  certificates  duly  executed  before  a judge  of  a 
court  of  record  must  be  furnished  to  the  superintendent  of  the 
asylum  as  a justification  for  further  detention. 

Viewed  without  prejudice,  this  course  seems  the  only  one  which 
can  be  pursued,  and  consequently  we  deem  it  right.  For  to  wait 
man}"  hours  or  several  days  for  all  the  legal  forms  of  commitment 
to  be  executed,  might  endanger  the  life  of  the  patient  or  of  those 
about  him.  Still  it  must  be  remembered  that  such  cases  of  very 
severe  acute  mania  are  rare.  In  most  cases  a delay  of  twenty-four 
hours  can  do  no  harm. 

2.  The  same  patient  recovers  in  greater  part;  he  becomes 
quiet,  and,  with  the  exception  of  an  occasional  false  notion  and  a 
degree  of  mental  enfeeblement,  is  like  most  well  men.  Yet  by 
virtue  of  the  power  of  the  original  commitment  this  man  is  kept 
confined  to  the  asylum,  he  is  yet  a prisoner.  If  he  wishes  to  walk, 
or  to  breathe  fresh  air,  or  to  attempt  some  little  outdoor  work, 


PAPER  BY  DR.  E.  C.  SEGUIN. 


23 


£ 


doors  must  be  unlocked  to  let  him  pass,  and  when  he  returns  to  his 
room  or  ward  he  is  locked  in  for  the  night.  And  this  stage  of 
partial  recovery  may  last  almost  indefinitely.  The  sole  power  of 
discharge  rests  in  the  judgment  and  hands  of  a single  man,  the 
superintendent ; the  patient  is  practically  under  a most  singular 
Torm  of  tyranny  for  any  enlightened  state  to  permit  to  flourish. 

No  matter  how  scientific  or  how  good  a man  the  superintendent 
may  be,  I hold  that  this  degree  of  authority,  of  uncontrolled 
authority  over  the  liberty  of  citizens,  ought  not  to  be  allowed. 

3.  The  same  sort  of  a case,  i.  e.,  one  of  acute  mania,  terminates 
unfavorably.  The  delirium  is  transformed  into  a group  of  more 
or  less  fixed  delusions,  kept  up  by  hallucinations  ; the  memory  and 
judgment  are  fatally  impaired, — in  other  words,  secondary  dementia 
is  established.  If,  as  in  innumerable  cases  now  in  asylums,  the 
delusions  of  the  patient  are  not  delusions  of  persecution,  or  of  any 
other  form  likely  to  lead  to  an  outbreak  of  violence  or  destructive- 
ness, is  it  right  to  keep  this  patient  in  the  more  or  less  costly  and 
elegant  prisons  we  call  asylums  ? 

Why  should  not  these  remains  of  a man  enjoy  freedom  under  a 
certain  supervision?  Why  should  he  not  be  allowed  to  go  and 
come  as  he  pleases  and  to  have  what  little  pleasure  there  remains 
for  him  in  life  ? 

Let  us  make  a further  supposition,  which  is  perfectly  in  accord 
with  cases  daily  observed.  If  this  harmless  dement  has  property 
of  his  own,  why  should  not  this  property  be  used  to  provide  him 
with  a suitable  mode  of  life,  and  expended  in  reasonable  amount 
for  his  benefit  ? There  is  good  reason  to  believe  that  many  such 
patients  are  kept  in  asylums,  private  or  public,  indefinitely,  unpro- 
vided with  the  luxuries  or  quasi-luxuries  to  which  they  are  entitled. 
After  a few  years  of  patience  on  the  part  of  the  relatives,  and  of 
more  or  less  conscious  misery  on  the  part  of  the  patient,  the  disease 
ends  in  death,  and  the  carefully  preserved  property  of  the  deceased 
is  duly  apportioned  among  heirs. 

4.  A woman  drifts  through  domestic  trouble,  semi-starvation, 
intp  a state  of  cerebral  mal-nutrition  and  anaemia ; delusions  of  a 
melancholic  type  appear,  together  with  a depression  and  sadness 
which  cannot  be  reacted  against. 


Is  it  right  to  imprison  such  a woman,  to  place  her  actually  under 
lock  and  key  for  months  ? 

In  some  cases  I am  willing  to  admit  that  it  is  justifiable,  but  in 
the  majority  of  cases  I believe  that  such  a procedure  is  unjust, 


tt  4 f 


24 


THE  RIGHT  OF  THE  INSANE  TO  LIBERTY. 


morally  and  legally,  and  decidedly  opposed  to  the  patient’s 
recovery. 

To  decide  which  cases  belong  to  the  former  category  and  which 
to  the  latter,  and  to  judge  when  a given  case  passes  from  one 
category  into  the  other,  requires,  I admit,  careful  observation  and 
ripe  judgment,  but  no  more,  I am  prepared  to  maintain,  than  do 
many  other  problems  in  medicine  and  surgery  which  are  decided 
every  day  in  our  midst  with  average  good  success. 

5.  Cases  of  primary  dementia  occur  frequently  in  both  middle- 
aged  and  old  people.  Many  such  patients  are  simply  foolish,  but 
quite  harmless.  Why  are  they  sent  to  asylums,  except  for  safe 
keeping,  because  of  the  lack  of  relatives,  or  because  of  pecuniary 
inability  of  friends  to  take  care  of  the  deteriorating  member  of 
the  family ; or  lastly,  pretty  often,  I fear,  because  of  unwillingness 
to  keep  the  patient  at  home  ? 

In  all  these  three  categories  I believe  that  confinement  under  the 
present  asylum  system  is  unjustifiable,  legalfy  and  morally. 
^-'''What  right  have  we  to  bar  a man’s  window  and  keep  him  all 
day,  or  part  of  the  day,  for  months  and  years,  under  lock  and  ke}’, 
Nbecause  he  is  simple  or  foolish,  or,  to  put  it  technically,  demented? 

' The  pauper  insane  of  the  harmless  demented  class  must,  I 
suppose,  be  aggregated  in  institutions,  preferably  under  medical 
supervision,  if  not  medical  control,  but  have  we  not  the  right  to 
^"demand  that  these  unfortunates  shaH  have  the  maximum  of  personal 

Giberty  consistent  with  safety  to  themselves  and  others ; that  they 
ball  be  both  employed  and  amused  in  an  inexpensive  manner? 
A^ust  we  not  remember  that  so  long  as  any  reason  survives,  perhaps 
longer,  the  animal  capacity  for  simple  enjoyment  persists  ? How 
many  hundred  chronic  insane  in  this  nation  are  quite  capable  of 
\j  enjoying  a game  of  cards  or  dominoes,  bowling,  a pipe  of  tobacco, 

\etc.,  in  comparative  freedom,  under  a surveillance  that  need  not  at 
all  resemble  the  present  prison-like  manner  of  watching  patients  in 
asylums  ? 

6.  Epileptic  and  hysteric  patients  are  rarely  detained  in  asylums 
without  justification.  I have  had  personal  knowledge  of  such 
cases. 

The  alleged  cause  of  certification  originally,  and  of  unlimited 
detention  afterward  at  the  request  of  relatives,  is  some  psychical 
disorder  which,  in  a majorit}r  of  cases,  is  temporary,  and  quite  as 
much  under  the  control  of  a physician  as  of  a superintendent. 


PAPER  BY  DR.  E.  C.  SEGUIN. 


25 


I do  not,  let  it  be  clearly  understood,  mean  to  say  that  such 
cases  should  not  be  sent  to  institutions,  but  I protest  most  energeti- 
cally against  their  commitment  to  prison-like  asylums,  to  their 
forced  association  with  the  insane,  and  their  subjection  to  the 
imperfect  medical  treatment  which  obtains  in  most  asylums. 

Removal  from  home  often  does  much  good  in  these  diseases,  and 
is  a sine  qua  non  to  recovery  in  certain  cases  of  hysteria  ; but  from 
this  statement  to  the  present  evil  practice  of  judicial  commitment 
and  locking  up  there  is  a vast  gulf  — a gulf  as  deep  and  wide  as  is 
the  great  human  right  to  personal  liberty. 

I do  not  mean  to  refer  in  detail  to  a last  class  of  cases,  viz., 
those  in  which  a sane  person  is  fraudulently  imprisoned  as  insane 
under  our  present  imperfect  laws. 

I firmly  believe  that  such  cases  are  extremely  rare,  and  from  my 
personal  knowledge  of  many  of  the  superintendents  of  insane 
asylums,  I do  not  believe  that  any  of  those  gentlemen  would  for 
one  moment  countenance  such  a procedure. 

I trust  that  I have  made  myself  understood. 

With  many  others,  some  of  them  to  be  cited  further  on,  I believe  : 
/ (a)  That  a large  number  of  the  inmates  of  asylums  could  be 
f taken  care  of  with  open  doors  and  unbarred  windows,  and,  of 
f course,  without  restraining  apparatus. 

(6)  That  many  insane  now  confined  in  our  asylums  could  be 
trusted  almost  implicitly  to  go  and  come  at  will ; could  be  given 
nominally  remunerative  occupation,  and,  above  all,  could  be  pro- 
vided with  simple  amusements  suited  to  their  stations  in  life  (and 
I do  not  refer  to  costly  stereopticons,  or  the  solitary  billiard  .table, 
or  the  lectures,  to  which  superintendents  now  refer  with  so  much 
complaisance) . 

(c)  That  the  phases  of  insanity  should  be  watched  more  closely, 
with  especial  reference  to  early  discharge  of  a patient ; to  his 
transfer  to  another  institution ; to  the  amount  of  liberty  allowed 
him,  etc.  And  I do  not  think  it  safe_t.o  J.eave  this  power  wholly 
in  the  hands  of  the  superintendent. 

Jd)  That  the  time  has  come  to  look  around  and  attempt  in  this 
country  the  English  and  Scotch  plan  of  placing  harmless  insane 
persons  singly  in  the  families  of  farmers,  and  of  others  willing  to 
undertake  the  task  under  frequent  and  efficient  visitation. 

There  is  not,  I dare  say,  a single  county  in  the  State  of  New 
York  where  a number  of  harmless  chronic,  or  even  sub-acute, 


26 


THE  RIGHT  OF  THE  INSANE  TO  LIBERTY. 


cases  of  insanity  might  not  be  safely  and  happily  treated  or  kept  in 
families,  and  where  a good,  yet  just  and  firm  country  doctor,  could 
not  be  found  to  visit  a dozen  or  more  of  these  patients  occasionally 
and  unexpectedly,  and  keep  a strict  watch  over  their  health  and 
happiness,  reporting  fully  to  the  State  Commissioner  or  Com- 
missioners of  Lunacy,  or  to  a special  general  inspecting  official. 

There  are,  I have  reason  to  believe,  many  families  who  would 
much  prefer  to  keep  their  insane  in  this  manner,  at  a reasonable 
cost,  who  are  made  to  shudder  at  the  mere  mention  of  an  asylum, 
whose  long  and  desolate  corridors  they  see  in  imagination,  whose 
locks  and  keys  they  almost  think  they  can  hear,  and  whose 
deteriorating  influences  upon  patients  they  more  than  half  suspect. 

While  expressing  the  above  views  I also  desire  to  state  just  as 
clearly  my  belief  that  certain  cases  of  insanity,  more  especially  acute 
mania  or  melancholia,  all  psychosis  accompanied  by  homicidal, 
suicidal  or  marked  destructive  tendencies,  should  be  placed,  as 
quickly  as  the  law  will  allow,  in  confinement.  But  even  here  we 
may  implore  that  the  confinement  may  be  made  as  easy  as  possible 
for  the  unfortunate  patient,  who  is,  contrary  to  public  prejudice, 
just  as  much  a sick  man  as  if  he  had  phthisis  or  a chronic  ulcer ; 
and  that  all  the  barbarous  means  of  corporeal  restraint,  such  as 
cribs,  jackets,  straps,  etc.,  shall  be  radically  done  away  with  as 
asylum  implements,  as  a part  of  the  nosocomial  armamentarium , 
and  only  applied  by  express  directions  of  the  medical  officer  in 
exceptional  cases,  very  much  in  the  same  way  as  we  resort  to 
heroic  medication  or  surgical  procedures  in  general  practice. 

If  you  will  pardon  a simile,  I would  say  that  I look  upon  restrain- 
ing apparatus  in  the  treatment  of  insanity  very  much  as  upon  the 
lancet  in  the  treatment  of  general  diseases.  The  sight  of  restrain- 
ing apparatus  in  an  asylum  seems  to  me  as  demoralizing  and 
uncalled  for,  as  would  be  the  carrying  of  a lancet  and  the  celebrated 
palette  by  a physician  of  today  in  his  hospital  visit.  Bleeding  is 
generally  condemned,  and  so  is  physical  restraint  of  the  insane, 
^e^cepting  in  this  country,  and  yet  I will  not  deny  but  that  once  in 
a while,  under  peculiar  circumstances,  both  phlebotomy  and 
estraint  are  justifiable.  Let  us  join  in  the  hope  that  before  many 
r"ears  both  procedures  will  be  equalty  rare. 

^ I desire  to  close  this  essay  by  reference  to  the  opinions  of  much 
abler  men,  and  much  more  expert  specialists  than  myself  upon 
this  subject.  And  I believe  that  the  gentlemen  whose  views  I am 


PAPER  BY  DR.  E.  C.  SEGUIN. 


27 


to  quote  are  so  eminent  in  their  specialty  that  the  most  bigoted 
defender  of  our  present  prison  system  of  asylums  cannot  question 
their  right  to  be  considered  as  foremost  authorities. 

/^T)r.  Henry  Maudsley,  who  has  held  almost  every  possible  officialN 
^position  in  relation  to  insane  administration  in  England,  and 
who  is  justly  regarded  as  one  of  the  most  distinguished  European 
alienists,  expressed  himself  as  follows,  years  ago  : I quote  from 
the  second  edition  of  4 4 The  Physiology  and  Pathology  of  the 
Mind  ” (London,  1868) : 

44  To  be  a lunatic,  as  public  sentiment  goes,  is  to  be  cut  off 
socially  from  humanity.  With  such  feeling  prevalent  with  regard 
to  the  insane,  can  it  be  thought  possible  that  the  treatment,  at 
present  sanctioned  by  general  approbation,  should  be  the  most 
just  and  humane  possible  ? The  feeling  is  one  which  cannot  be 
justified,  and  the  system  which  it  inspires  cannot  be  just.  That 
system  is  the  system  of  indiscriminate  sequestration  — of  locking 
up  a person  in  an  asylum  simply  because  he  is  mad. 

44  Now,  I believe  this  practice  to  spring  out  of  an  unjust  feeling, 
as  already  said,  and  to  be  founded  on  false  principle,  as  I shall  now 
endeavor  to  show.  The  principle  which  guides  the  present  practice 
is  that  an  insane  person,  by  the  simple  warrant  of  his  insanity, 
should  be  shut  up  in  an  asylum,  the  exceptions  being  made  of 
particular  cases.  This  I hold  to  be  an  erroneous  principle.  The 
true  principle  to  guide  our  practice  should  be  this  : that  no  one, 
sane  or  insane,  should  ever  be  entirely  deprived  of  his  liberty, 
unless  for  his  own  protection  or  for  the  protection  of  society.” 
(pp.  494,  495.) 

44 1 venture,  indeed,  to  affirm  in  opposition  to  it,  that  there  are 
many  chronic  and  incurable  insane  persons,  neither  dangerous  to 
themselves  nor  to  others,  who  are  at  present  confined  in  asylums, 
and  who  might  as  well  be  at  large.”  (p.  495.) 

“Another  objection  to  the  liberation  advocated  will  be,  that 
the  insane  in  private  houses  will  not  be  as  well  cared  for  as  they 
are,  nor  have  any  more  comfort  than  they  now  have,  in  well- 
conducted  asylums.  The  quarter  from  which  this  objection  is 
urged  taints  it  with  suspicion ; I never  heard  it  put  forward  but 
by  those  who  are  interested  in  the  continuance  of  the  present 
state  of  things.  Those  who  make  it,  appear  to  fail  entirely  to 
appreciate  the  strength  of  the  passion  for  liberty  which  there  is  in 
the  human  breast ; and  as  assuredly  there  are  but  very  few  persons 


28 


THE  RIGHT  OF  THE  INSANE  TO  LIBERTY. 


who  would  not  infinitely  prefer  a garret  or  a cellar  for  lodgings, 
with  bread  and  water  only  for  food,  to  being  clothed  in  purple  and 
fine  linen,  and  faring  sumptuously  every  day  as  prisoners ; I can 
well  believe  that  all  the  comforts  which  the  insane  person  has  in 

fhis  captivity  are  but  a miserable  compensation  for  his  entire  loss 

of  liberty,  that  they  are  petty  things,  which  weigh  not  at  all 

against  the  mighty  suffering  of  a life-long  imprisonment.”  (pp. 
496,  497.) 

“ For  the  reasons  adduced,  I cannot  but  think  that  future 
1 J progress  in  the  improvement  of  the  treatment  of  the  insane,  lies 

WT  in  the  direction  of  lessening  the  sequestration  and  increasing  the 

liberty  of  them.”  (p.  501.) 

“Not  the  least  of  the  evils  of  our  present  monstrous  asylums, 
is  the  entire  impossibility  of  anything  like  individual  treatment  in 
them.”  (p.  502.) 

“Indeed,  I cannot  help  feeling,  from  my  experience,  that  one 
~~T  effect  of  asylums  is  to  make  some  permanent  lunatics.  * * * 

And  I can  certainly  call  to  mind  more  than  one  instance  in  which 
t I thoroughly  believe  that  the  removal  of  a patient  from  an  asylum 
was  the  salvation  of  his  reason.”  (p.  503.) 

Our  distinguished  countryman,  Dr.  Samuel  G.  Howe,  everywhere 
known  for  his  philanthropic  efforts,  enters  a noble  protest  against 
the  unnecessary  restraint  of  lunatics  by  confinement  to  asylums, 
in  the  Sixth  Annual  Report  of  the  State  Board  of  Charities  of 
Massachusetts,  for  1869.  I quote  : 

“Yes,  disguise  it  as  we  may,  we  do  keep  under  unnecessary 
restraint  and  in  a sort  of  slavery,  a multitude  of  unfortunates  who 
sigh  for  liberty,  and  to  whom  it  would  be  very  sweet.  Their 
appearance  of  quiet  and  their  seeming  acquiescence  are  oftentimes 
utterly  deceptive.  Bewildered,  doubtful  of  their  own  power  of 
self-guidance,  half  conscious  of  insanity,  still  they  know  enough 
to  know  that  the  whole  power  of  society  holds  them  in  its  grip, 
(_  and  they  resign  themselves  in  despair.”  (p.  lxxxvii.) 

“It  would  be  folly  to  deny  that  restraint  by  walls,  by  iron 
sashes,  by  oaken  doors  and  by  constant  guard  is  necessary  for  a 
certain  class  of  patients  under  our  mode  of  treatment.  But  it  is 

r equal  folly  to  maintain  that  it  is  necessary  for  all,  or  for  nine- 
tenths  ; and  if  not  necessar}^,  upon  what  ground  can  we  defend  our 
\ violation  of  a right  which  the  lunatic  never  forfeited  ? 

“ It  is  sinful  and  criminal  to  abridge  unnecessarily  the  freedom  of 


PAPER  BY  DR.  E.  C.  SEGUIN. 


29 


an  innocent  man ; and  it  is,  moreover,  cowardly  and  cruel  to 
abridge  that  of  an  unfortunate  lunatic.”  (p.  lxxxix.) 

In  the  next  place  I quote  from  G.  Fielding  Blandford’s  work  on 
“Insanity  and  its  Treatment”  (London  edition,  1870,  American 
edition,  1871).  He  says  : 

“ Doubtless,  you  have  all  heard  of  the  moral  tresitment'-  oL 
insanity,  fait-  shutting  a_rnnn  up  in  an^^hrnT"ean"  bnr(l ly  be  called 
moral  treatment.”  (p.  379.) 

u In  asyluifis  they  dwelt  from  3^ear  to  year,  a few  walking  beyond 
the  premises,  but  none  sleeping  beyond,  or  going  to  any  places  of 
amusement  like  ordinary  men.  Now,  from  all  asjdums  patients 
are  sent  to  the  sea-side,  to  the  theatre,  the  picture  galleries,  and 
each  proprietor  vies  with  his  fellows  in  providing  recreation  and 
entertainment  for  his  patients  — in  proving,  in  fact,  how  little  they 
need  the  restraint  of  an  asylum.”  (p.  383.) 

[The  above  passage  applies  only  to  a special  class  of  private 
asylums  in  Great  Britain,  but  its  bearing  on  the  general  question  is 
obvious.] 

“ As  the  last  generation  did  away  with  the  fetters  and  mechanical 
restraint  used  in  asylums,  so  let  the  present  release  from  the 
restraint  of  an  asylum  all  those  capable  of  enjoying  a larger  amount 
of  liberty  and  a freer  atmosphere  than  that  in  which  they  now  fret 
and  chafe.”  (p.  385.) 

Dr.  John  Charles  Bucknill  is  known  to  the  profession  in  this 
country  as  an  eminent  authority  upon  the  topic  in  hand. 

He  has  this  spring  given  us  in  book-form  the  series  of  papers  on 
Lunacy  Law  Reform  which  appeared  in  the  British  Medical  Journal 
in  1879.  The  purpose '6f“fhese'papersds-mainly  warfare  upon  the 
private  or  proprietary  asylums  as  they  flourish  in  England,  but 
scattered  throughout  the  volume  are  numerous  passages  proving 
how  thoroughly  Dr.  Bucknill,  after  a most  varied  experience  with 
the  insane  and  with  asylums,  coincides  with  Dr.  Maudsley  in  the 
opinion  that  for  many  cases  of  insanity  or  mental  unsoundness 
confinement  to  an  asylum,  subjection  to  asylum  routine,  and 
deprivation  of  liberty  and  social  enjoyments  are  cruel,  and  legally 
unjustifiable. 

I quote  a few  sentences  only : 

“ Custom-blindness  (which  is  more  than  color-blindness,  because 
it  blurs  the  outline  of  things  as  they  are)  often  leads  official  people 
to  associate  unsoundness  of  mind  with  detention  under  care  and 


30 


THE  RIGHT  OF  THE  INSANE  TO  LIBERTY. 


treatment  as  correlative  if  not  identical  conditions ; but  with  the 
general  public  it  is  not  so,  and  still  less  with  the  medical  profession, 
and  still  less  again  with  that  of  the  law.”  (pp.  25-26.) 

“ * * * And,  therefore,  it  would  appear  to  be  imperative  to 

' a proper  certification  of  a lunatic  for  detention  in  an  asylum  that 
the  reasons  for  which  such  detention  is  needful  should  be  fully 
stated  upon  the  face  of  the  documents,  and  distinguished  from  the 
facts  which  simply  indicate  lunacy.”  (p.  26.) 

“But  it  is  not  merely  the  happy  change  which  takes  place  in 
confirmed  lunatics  when  they  are  judiciously  removed  from  the 
dreary  detention  of  the  asylum  into  domestic  life,  it  is  the  efficiency 
of  the  domestic  treatment  of  lunacy  during  the  whole  course  of  the 
disease  which  constitutes  its  greatest  value,  and  of  this  the 
/author’ s fullest  and  latest  experience  has  convinced  him  that  the 
figurative  influences  of  asylums  have  been  vastly  overrated,  and 
/ that  those  of  isolated  treatment  in  domestic  care  have  been  greatly 
( undervalued.”  (p.  114.) 

“ Many  a suicidal  patient  can  live  as  safely  with  two  faithful  and 
skilful  attendants  in  a villa  or  cottage  as  in  any  asylum,  and  in  the 
free  air  he  will  walk  or  drive,  employ  or  amuse  himself  in  various 
ways,  and  recover  without  the  asylum  brand  or  the  asylum  danger 
of  falling  more  and  more  into  subjective  ways  of  thought  and 
\ shunting  into  the  sad  list  of  incurables.”  (p.  116.) 


The  President  (Dr.  Wilbur)  : In  connection  with  this  paper 
I will  make  a single  observation.  When  in  London  the  last  time, 
I visited  the  Bedlam  Hospital  of  centuries  ago,  an  endowed  institu- 
tion of  a semi-private  character,  where  they  are  able  to  take  patients 
from  what  are  called  the  middle  classes,  and  among  other  patients 
in  it  are  many  infirm  actors  and  actresses,  and  as  an  act  of  grate- 
ful recognition  on  the  part  of  the  profession  for  the  kindness 
vouchsafed  by  that  institution,  complimentary  tickets  are  often 
sent  to  it ; and  on  the  morning  of  my  visit,  while  present  with  the 
officers,  a list  was  made  out  of  those  in  the  institution  who  should 
be  selected  to  attend  the  theatrical  performance  of  the  evening. 


LETTER  FROM  MR.  SEWALL 


31 


The  President  (Mr.  Sanborn)  : I will  now  read  a letter  from 
one  of  the  oldest  lawyers  and  philanthropists  of  Massachusetts  — 
Mr.  Samuel  E.  Sewall,  of  Boston  — whose  ancestor  — Chief  Justice 
Sewall  — was  one  of  those  judges  who  sentenced  the  Salem  witches 
"to  death,  and,  some  years  after,  stood  up  in  church  on  Sunday  and 
.repented  publicly  his  great  sin  in  that  matter.  The  letter  makes 
a valuable  suggestion  for  the  Conference  to  consider : 

Boston,  June  25,  1880. 

Dear  Miss  Chevaillier  : 

The  circular  in  regard  to  a “National  Association  for  the  Protection  of  the 
Insane,”  with  the  invitation  to  attend  a meeting  of  the  Conference  of  Charities, 
was  duly  received.  I certainly  desire  to  be  enrolled  as  a member  of  such  an 
association,  if  one  be  formed.  I had  intended  to  write  some  remarks  respecting 
the  laws  regulating  lunatic  hospitals,  but  I have  been  so  pressed  by  urgent 
affairs  that  I gave  up  the  design.  One  point,  however,  I hope  you  will  bring 
before  the  meeting.  It  is  the  importance  of  having  a full  abstract  made  of 
the  laws  of  all  the  States  regarding  lunacy.  It  is  a laborious  task,  but  when 
done  it  cannot  fail  to  be  highly  useful.  Among  the  immense  mass  of  crude 
and  unwise  legislation  there  cannot  fail  to  be  found  some  valuable  sugges- 
tions for  future  reform,  — a few  ounces  of  gold  in  a ton  of  stone.  Could  not 
a committee  be  appointed  to  undertake  this  work,  and  also  the  same,  or 
another  committee  to  prepare  annually  a summary  of  all  important  facts  to  be 
gathered  from  the  reports  of  the  lunatic  hospitals  throughout  the  United  States, 
in  a tabular  form,  or  otherwise;  and  to  collect  from  them  useful  ideas  for 
reform?  I cannot  act  on  any  committee,  but  throw  out  these  thoughts  for 
your  consideration. 

I am  very  glad  you  are  to  be  at  the  meeting  in  Cleveland.  It  makes  me 
feel  sure  that  something  will  be  done. 

Yours,  very  truly, 


S.  E.  SEWALL. 


. 

* 

' 

' 


